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Chapter 25

Chapter 25. Care of Patients with Infection. Definitions. Pathogen—any microorganism capable of producing disease Communicable—infection transmitted from person to person Pathogenicity—the ability to cause disease Virulence—the degree of communicability. Definitions (Cont’d).

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Chapter 25

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  1. Chapter 25 Care of Patients with Infection

  2. Definitions • Pathogen—any microorganism capable of producing disease • Communicable—infection transmitted from person to person • Pathogenicity—the ability to cause disease • Virulence—the degree of communicability

  3. Definitions(Cont’d) • Normal flora—characteristic bacteria of a body location; it often competes with other microorganisms to prevent infections • Colonization—the microorganism present in tissue but not yet causing symptomatic disease • Surveillance—the tracking and reporting of infections

  4. Overview of Chain of Infection • Reservoirs • Pathogens: • Toxins • Exotoxins • Endotoxins • Host Defenses: • Susceptibility

  5. Immunity • Resistance to infection is usually associated with the presence of antibodies or cells acting on specific microorganisms.

  6. Immunity (Cont’d) • Passive immunity is of short duration, either naturally by placental transfer or artificially by injection of antibodies. • Active immunity lasts for years and occurs naturally by infection or artificially by stimulation (vaccine) of immune defenses.

  7. Antibodies

  8. Antibodies Mechanism of Action

  9. Portal of Entry Sites • Respiratory tract • GI tract • Genitourinary tract • Skin/mucous membranes • Bloodstream

  10. Mode of Transmission • Contact transmission by direct or indirect contact • Droplet transmission such as in influenza • Airborne transmission such as in tuberculosis • Contaminated food or water • Vector-borne transmission involving insect or animal carriers, such as in Lyme disease • Portal of exit

  11. Physiologic Defenses Against Infection • Body tissues • Phagocytosis • Inflammation • Immune systems: • Antibody-mediated immune system • Cell-mediated immunity

  12. Infection Control in Inpatient Health Care Agencies • Health care–associated Infection (HAI) is acquired in the inpatient setting; not present at admission. • Endogenous infection is from a patient’s flora. • Exogenous infection is from outside the patient, often from the hands of health care workers.

  13. Methods of Infection Control • Practice hand hygiene and proper handwashing. • Personal protective equipment (PPE).

  14. Nurse in Personal Protective Equipment Caring for Patient in Protective Isolation Room

  15. Infection Control • Adequate staffing • Sterilization • Disinfection • Patient placement: • Cohorting • Patient transportation

  16. CDC and Prevention Transmission–Based Guidelines • Standard Precautions: • Respiratory hygiene/cough etiquette (RH/CE) • Safe injection practices

  17. Transmission-Based Precautions • Airborne Precautions • Droplet Precautions • Contact Precautions

  18. Methicillin-Resistant Staphylococcus Aureus (MRSA) • Vancomycin • Linezolid • Community-associated MRSA • The best way to decrease the incidence of this growing problem is health teaching

  19. Other MDROs • Vancomycin-resistant Enterococcus (VRE) • Multidrug resistant tuberculosis • Gonorrhea • Vancomycin-intermediate Staphylococcus aureus (VISA) • Vancomycin-resistant S. aureus (VRSA)

  20. Problems from Inadequate Antimicrobial Therapy • Noncompliance or nonadherence • Legal sanctions that compel a patient to complete treatment, such as in the instance of tuberculosis • Septicemia • Septic shock

  21. Collaborative Care • History • Physical assessment and clinical manifestations • Psychosocial assessment

  22. Collaborative Care(Cont’d) • Laboratory assessment including: • Culture and antibiotic sensitivity testing • Complete blood count • Erythrocyte sedimentation rate • Serologic testing • Imaging assessment

  23. Community-Based Care • Home care management • Health teaching • Health care resources

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